The role of videofluoroscopy and ultrasound in assessing pharyngoesophageal muscle tone after laryngectomy.

The aim of this study was to compare the respective value of videofluoroscopy and ultrasound for assessment of the tonicity of the neoglottis and determination of the exact neolaryngeal segment of hypertonicity. We examined twelve patients who had developed inadequate tracheoesophageal voice following total laryngectomy and installation of tracheoesophageal prosthesis. We assumed that the cause of the unsatisfactory voice quality in our patients was neolaryngeal muscle spasm. After determining the exact hypertonic segment, we administered lidocaine intramuscularly and tried to act on the hypertonic segment. By means of videofluoroscopy as gold standard for comparison with ultrasound examination, we followed the passage of contrast through the neo-larynx and watched for dilatation of the segment during swallowing, phonation and at rest to determine whether there were any tonus disturbances or differences before and after lidocaine injection. In conclusion, a combination of the two methods could yield better results in voice restoration. Videofluoroscopy is the method of choice for initial assessment and determination of the hypertonic segment, while ultrasound is the method to apply to facilitate administering the drug more precisely.

Microbial colonization of tracheoesophageal voice prostheses (Provox2) following total laryngectomy.

The purpose of this study was to determine the presence of individual microorganisms and the most frequent microbial combinations in the biofilm of the indwelling Provox2 voice prosthesis in situ. Furthermore, we wanted to evaluate the possible influence of biofilm composition on the mean and median lifetime of these voice prostheses. Over a 5-year period, implantation of a Provox2 voice prosthesis was performed in 85 patients, or 90% of the overall number of patients who underwent total laryngectomy. In total 100 implanted voice prostheses, at least one of every patient, were microbiologically processed immediately after being replaced. Out of the total of 292 isolates, 67% were bacteria and the remaining 33% were yeasts. The most frequently found yeast species on voice prostheses biofilms was C. albicans, followed by C. krusei and C. tropicalis. The most frequently isolated bacteria included Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis, and Streptococcus agalactiae. Simultaneous presence of bacteria and fungi was established in 83% of the processed voice prostheses; in 16% of samples the biofilm contained only one or more bacterial species. The mean time of implantation was 238 days and the median lifetime of the device was 180 days. Dividing the prostheses in four groups according to the composition of biofilm revealed that the device lifetimes varied significantly between groups. The longest lifetime of voice prostheses was associated with the presence of single fungal isolate in combination with bacteria. There is a significant correlation between biofilm composition and the device life time.

Congenital laryngeal cyst: one or two cysts.

The case presented is of a neonate with extreme respiratory distress immediately after birth, caused by a large laryngeal cyst. The vertical diameter of the cyst was larger than the height of the neonatal larynx. First excision of the cyst was performed in the region of the prominent aryepiglottic fold. Three weeks later, because of a recurrence of dyspnea, excision of the prominent wall of an obstructing cystic lesion was performed in the ventriculus Morgagni.